Although based on Dialectical Behavioral Therapy (DBT), the NLRW workshop emphasizes the relevance of facilitators who are also people in recovery (peers) and are not professionals offering any form of therapy. To ensure this understanding, skills are referred to as Dialectical Behavioral Techniques (DBT*) and are not intended as a replacement for professional therapy/mental health treatment. The Peer Support Workers who facilitate the workshop are far along in their recovery from mental illness, have extensive knowledge of DBT and regularly apply the skills to their daily lives.

So, why peer-led? The unique perceptive of “somebody who’s been there” and knows what it is like to have a mental illness that causes overwhelming and painful emotions is something very special indeed and not something that most people experience in a professional therapeutic relationship. Our participants tell us “I feel less alone”,  “I really appreciate the opportunity to share with others who understand me”, “I like that we are all in this learning together” and “I just love that this workshop is peer-driven.” In other words, peer-led DBT* gives our participants hope that they to can and will experience recovery!

The prime reason for joining this workshop for participants is to help them deal with various forms of self-destructive behavior that make it difficult for them to experience a quality of life due to emotional dysregulation. Participants have various mental illness including Clinical Depression, Anxiety Disorders, Borderline Personality Disorder (BPD) and Bipolar Disorder. Some participants are dealing suicidal thoughts and behaviors, self-injury and substance abuse.

Overall, participants learn how to create “a life worth living” through regulating their emotions and handling daily stress. Like traditional DBT, the NLRW covers all four skill building modules including Core Mindfulness, Distress Tolerance, Emotional Regulation and Interpersonal Effectiveness. Participants also learn to validate their own and other peoples’ experiences and about dialectical relationships (what happens when two opposites combine to make something new). Unlike traditional DBT, participants do not receive individual counseling or phone support, although we do aim to make the group a nurturing and caring environment to learn and grow.

Currently, the workshop is in the midst of its third full run though. After the completion of the pilot workshop, a detailed report was developed evaluating the workshop and future  development. The following is a sample of feedback provided:

“Excellent. We need mentoring programs from those with lived experience. Lived experience is often more valuable than people who have gone to school. This is the only course that has really suited and helped me.”

“It was worth my time and made a difference”

“ I am still doing my diary cards! I have learned “Radical Acceptance”, “One- Mindfully”, “Participate”, and “opposite Action” – when I don’t feel like doing something I do it anyway.”

“Very helpful because my expectations were surpassed. I learned a lot.”

“A needed service for people with BPD. I would highly recommend this workshop

“It is an excellent tool for recovery for my mental illness Borderline Personality Disorder.”

To see the full report, please visit: New Light Recovery Workshop Report. In the near future, we hope to have completed a second report consisting not only of qualitative measures, but also of quantitative measures of the workshops effectiveness.

Implications of this study are far reaching for various mental illnesses including Post Traumatic Stress Disorder (PTSD) and Borderline Personality Disorder (BPD). The research suggests an even closer relationship between biological and environmental factors than previously thought. This new understanding of how the brain works in the development of mental illness could lead to new and novel ways to both prevent and treat mental illnesses such as BPD.

To see the actual study please go here
To see an article on the study please go here

This is perhaps the moment we all have been waiting for – a real celebrity to come forward to be the face of  Borderline Personality Disorder (BPD)! Brandon Marshall, a pro-foot ball player is the first major celebrity to publicly share his battle with BPD. This  important announcement comes shortly after Marsha Linehen, Ph.D and developer of Dialectical Behavioral Therapy, also shared her battle with BPD as an adolescent.

Marshall details his long and painful struggle in the article written by Omar Kelly Brandon Marshall diagnosed with borderline personality disorder  in which he describes a lifetime of living with dramatic mood swings and uncontrolable emotional outbursts. This is all in spite of his great success as as the most highly paid professional football player in his position, a wonderful wife, college education (now pursuing his masters degree) and the house of his dreams.

“Before this ordeal I kept asking God to show me my purpose. He gave me this,” Marshall said. “I’ll be the face of BPD. I’ll make myself vulnerable if it saves someone’s life because I know what I went through this summer helped save mine.”

He is now endeavoring to advocate for more research into BPD and support services for those living with the disorder. He has also just lunched his trailer to a documentary called “Borderline Beast” in which he documents his recovery from BPD and stands out as the “Face of BPD”. Perhaps one of the most incredible things about this great reveal is that Marshal shows that BPD can effect anybody – male or female, rich or poor, successful…. Thank you Brandon! This is a gift to the whole BPD community.

Official Press Release

Now, for the first time at 68 years of age she reveals her own personal struggle with BPD in public before an audience of friends, family and colleagues at the Institute of Living. She holds nothing back as she shares her experience with multiple suicide attempts and self-harm. She also shares a religious experience in which she finally started loving and accepting herself. You can read her story and watch a video about her recovery in the Health section of the New York Times called Expert on Mental Illness Reveals Her Own Fight  written by Benedict Carey. It is truly inspiring to see a successful and well respected individual show the great courage it takes to speak out about this very stigmatized mental illness. Perhaps now, we finally have our role model! Somebody we can look up to and say, “she did it and so can I “. Speaking for people including family members, friends and those with BPD themselves we thank you, Marsha for your dedication and determination to help so many by developing DBT and sharing your story.

Borderline Personality Disorder (BPD) affects 2-3% of the population and is a devastating mental illness causing much suffering for both the individuals and family members and others who have an established relationship with the BPD person, including friends and significant others. The disorder itself causes rapid mood swings and difficulty controlling self-destructive impulses; emotion dysderegulation is at the core of this illness. Despite the seriousness of the disorder, recent research indicates that treatment can lead to considerable improvement over time, and that there is hope for recovery! Nevertheless, it is often difficult for individuals and families to find the support and treatment they so badly need due to stigma and lack of general awareness about the disorder.

Support Groups for other mental health conditions such as Schizophrenia, Bipolar Disorder, Major Depression and Anxiety Disorders are common. However, the idea of support groups for people with BPD and their family members is relatively new. Over the last few years, a small number of offline support groups have formed. One of these groups is the Borderline Personality Support Group (Victoria, BC Canada) run by Elizabeth Bogod and co facilitators. We would like to share some practical advice on forming a BPD support group in your area. Here is what we recommend:

1) Assess Your Wellness

Are you far enough along in your recovery to start a support group and effectively lead it? It is very important to be honest with yourself about this. Facilitating a support group is never easy and there are special challenges to facilitating a BPD support Group.  If your emotions are often overwhelming, you engage in impulsive behavior on a regular basis or you are only half way through treatment you might not be ready. Ask yourself if you are up for a challenge and are prepared to follow through with it in the long term.

2) Assess your facilitation skills

Have you ever facilitated a group before? Group facilitation requires a fine balance between using leadership skills to control the flow of conversation and letting conversation evolve naturally. If you want further training consider contacting NAIMI – take the Peer-to-Peer: NAMI’s Recovery Curriculum to learn more about peer support and mental illness. Also consider contacting the Canadian Mental Health Association or learn from a peer support manual . You can also work through the Shared Leadership Workbook. It is important that you not only share your journey with members of the group, but you must also provide amble opportunity for them to do the same. You will need use reflective listening skills to ensure everyone feels welcome and is able share based on their individual comfort level with disclosure.

3) Build a Team

If at all possible, partner with someone to help facilitate the group. There is nothing quite like having a co-facilitator to debrief with after the meeting or help you out when you are not sure what to say. Ideally we recommend you find one other person with BPD. Look for somebody who is well into their recovery like you are. It is not uncommon for family members including parents and partners to attend meetings. So we recommend that, in addition to having a second person with BPD, you have a family member on your team. The Borderline Personality Support Group is made up of two people with BPD and two moms. If you are just starting out and don’t know anybody with BPD or supporting family members, put out your feelers. Let mental health organizations know what you are trying to do. If you ultimately choose to start the group alone, keep your eyes out for good
co-facilitators.

4)      Build a set of group guidelines for the group or a “Comfort Agreement”. Your guidelines might include:

• Confidentiality  – What is said in the room stays in the room
• Be gentle and supportive with each other
• Share the air and be mindful of how much you’re sharing/speaking during meetings (Allow others to speak who are less extroverted)
• We do not discuss other group members when they are not present (even out of concern). This guideline ensure privacy of group members and avoid gossiping.
• Respect diversity (this includes ethnic, cultural, religious, sexual preference/identity and differences in ability)
• Respect differences of opinion
• Be Non-judgmental and keep an open mind
• Be gentle if offering advice, and offer only if asked –  Say something similar to “When I experienced something similar to your experience I tried this_________________.  Do you think that might help?”
• Own your Experiences “Use I language” Remember that while we share this disorder, each one of us has dealt with it differently and have used different coping skills and management styles to deal with this issue
• Avoid side talk and be respectful when others are speaking
• Participation is voluntary and you should never feel obligated to share
• If you are late, please sit down quietly and join the current conversation when it is appropriate
• Avoid graphic details about self-harm or other destructive behaviors that may trigger yourself or others

5) Consider how you will deal with special BPD issues in advance of meetings

a)  Splitting – Splitting is the tendency for people with BPD to see themselves and other people as either good or bad. It is “all or nothing thinking”. As a facilitator you need to be very aware of the probability that this may happen in your group. A difficult splitting situation may present itself if a participant decides to pit one facilitator against another or speak ill of another participant or facilitator. How can you handle this? First your “Comfort Agreement” will cover treating people with respect. Second, if you need to, you can simply ask to talk to the person in private, find out what is going on, state your own feelings of respect for the other person involved and remind them of the comfort agreement. Some people with BPD have insight into their splitting behavior and may appreciate your help with bringing them to a more balanced perspective.

b) Disturbing self-harm discussion – Many people with BPD self-injure or engage in impulsive, dangerous behaviors (usually self-destructive). These discussions can be very triggering for both the participant discussing the topic and other group members. How can you handle this? First your “Comfort Agreement” asks participants stay away from graphic detail about self-injury. If a participant is going into too much detail, you can always gently remind them of the guideline and what it is there for. You might say, “I am sensing the level of detail that ___________________(name) is going into about his/her self-harm is making others uncomfortable. What do others think? Shall we stop here?”. If the discussion continues, you may want to talk in private with the individual about what acceptable limits are for this type of disclosure. This is a touchy issue so you will need to make sure you are sensitive to the participant. It is important that he/she feels like they can share their struggles with the group while still maintaining a safe and supportive environment for all.

c)  Suicide threats – People with BPD often feel suicidal. Although this issue is rare in support groups, it can happen and you need to be prepared. All suicidal threats need to be taken seriously. If you have more than one facilitator (recommended) you will be able to handle this more effectively. Ideally the facilitator speaks to the suicidal individual in private. If you are that facilitator, you need to find out how immediate the danger is to the person. In other words, “Do they have a plan, and if so what is it?”. If they have a concrete plan most states and cities have crisis lines you can call to get emergency support. If the person has a weapon on hand, phone 911. In this case, do not deal with the crisis yourself. If the danger is not immediate, or they do not have a plan, ask them about their support systems .Do they have family or friends who can help them? Can they stay with someone? Help them arrange this, if possible. You will need to use your judgment. If you are unsure what to do, talk to your co-facilitators, contact a crisis line or talk to a mental health non-profit organization. After dealing with the situation, take some time to look after yourself. Suicide is a difficult issue. Debrief with another co-facilitator and/or take some “me time”- remember to self-soothe.

d)  Abusive Behavior- We add this one in with reservations because most people with BPD are not verbally abusive or violent. However, if this does occur ensure a safe environment is reestablished as soon as possible. Here is how you might handle a verbally abusive person effectively:

Identify their emotions “I see that you are very frustrated and upset” (never say angry as this might make them more angry)

Say you want to help – “….and I do want to help you….”

Ask for what you need – “It is hard for me to do this while you are swearing and raising your voice. I need you to lower your voice and stop swearing before I can help you.”

Offer to Listen after your request is met – “Then I will be happy to discuss the issue with you….”.

Once the group member has calmed down, speak to the person in private. Be sure to have another facilitator stay with the group. This facilitator may need to speak to the group about what just happened. He/she needs to direct conversation to how group members were affected and stay away from discussing the missing group member’s behavior. The comfort agreement is important in this situation: “We do not talk about other group members when they are not present (even out of concern)”.

6) Find a location to hold meetings

Get in touch with your local mental health organizations to see if a room might be available free of charge. Some cities offer rooms in libraries, churches or community halls free of charge. Aim to meet at least every two weeks in a month.

7) Establish your meeting time

For most people evenings are best. This is particularly true of family members of people with BPD who work during the day. Typically a meeting will run from 1.5 – 2 hours.  Be clear when setting your meetings, as it will be easy to go over the time scheduled.  Structure is very important, so if necessary, inform the group that you can resume an unfinished topic the following week

8) Structure your Meetings

Most people like to have structure to support group meetings. The key here is not to over structure your meetings. Here is a structure we have used successfully:

a)   Introduce Facilitator(s) – Provide your name(s) and share whether you have BPD or you are a family member/supporter of someone with BPD.

b)  Make Announcements – Share any special announcements with participants and ask if they have any news to share themselves. For example, you might announce community mental health events here, social events you have planned for the group, relevant newspaper stories, etc.

c)   Purpose Statement – Read out your purpose statement. Here the one we use in our Borderline Personality Support Group:

1.  We are here to support each other with compassion through our common experience of Borderline Personality Disorder (“Borderline” or “BPD”)

2.  We recognize that not everyone feels comfortable with the term Borderline.  Therefore, we use Borderline interchangeably with the term Emotional Regulation Disorder (ERD).

3.  We acknowledge that BPD/ERD is a serious mental illness, caused by biological and environmental factors affecting one’s ability to regulate emotions, control impulses, and enjoy healthy relationships.

4.  We welcome individuals with the disorder as well as family members, partners, and friends.

5.   We recognize that other conditions such as substance abuse, clinical depression, bipolar disorder and eating disorders often co-occur with this disorder.

6.  From time-to-time, individuals with other mental illnesses will visit us.  We welcome these individuals, but we keep in mind that our main focus is BPD/ERD.

d)  Check in – Everyone gets 2-3 minutes to say their name, whether they are a in recovery from BPD or a supporter, how they are doing and any topics they would like to discuss during “Open Sharing”.

e)   Open Sharing – Draw on the individual check-ins to start the conversation. Open up conversation to everyone. Allow plenty of time for “open table”.

f)    Collect Donations –Everyone is asked to make a small donation (only if they can) to buy refreshments, pay for photocopying costs, books, etc. Donations can be gathered in a can or any other container.

g)   Social Time – Provide Coffee, tea, cookies and, if possible, fruit. If there is no kitchen facility be prepared, to bring a coffee maker with you and all food supplies you will need. If you chose to meet in a restaurant you will not need to do this.

h)   Closing – Thank everyone for coming and let them know when the next meeting will be held.

9) Keep Records

Financial Records – You will need to keep a record of all your receipts, especially expenses related to food, photocopying costs and promotion. If you are able, build a spread sheet. If not, keep track of expenses on paper. Ideally it is best to designate a person to take this on who is comfortable with basic bookkeeping. This is particularly important if you hope to become a non-profit association in the future.

10) (Optional) Develop a Library

The Borderline Personality Support Group has purchased a number of BPD books which are available for loan. One of our volunteers administrates the library keeping track of who has borrowed what book and following up when books are overdue

11) Promote your Support Grou

a)      Advertise the support group in free community calendars and mental health newsletters

b)      Develop a brochure about your group and BPD

c)      Post your group on meetup.com

d)     Develop a blog for your group (See Borderline Personality Support Group Blog). You can use wordpress.com

e)    Get media attention – Contact your local newspapers, community television and ask them to do a story on BPD and the support group. Be prepared to share your own recovery story.

f)    Invite professionals from your local mental health authority/agencies  to observe your group in action to get referrals

We hope these tips will help you develop your own, unique BPD support group. Our dream is to one day have BPD support groups all over Canada and the United States and then perhaps in other countries too. If you use these tips we would love to hear your feedback. Tell us about yourself, the name of your support group and how these tips have helped you. You can email us at bpdvictoria@gmail.com

Yes, it is true. We are now growing! At our last meeting we had seventeen people attend, including our team of  three  facilitators. It is tremendous to see new faces at the group including individuals with BPD who now know they are not alone. It is wonderful to see family members attend, either with or without their loved ones, and to watch their realization that their is hope for recovery. And, of course, who can forget our regulars who show great courage and determination every time they come through the door. It is your dedication to the group that keeps us going.

At first, we were unsure about combining people with the disorder with family and friends, but now we have received positive feedback that this combination has actually increased insight and compassion between members. Family members tell us that they have a better understanding of what is like to have BPD and how to help. Participants feel they have more insight into the difficulties family members face with the symptoms of BPD and the effects of interpersonal dysregulation.

But support is not all we offer. We also offer individuals and families the chance to connect socially during the last half hour of the meeting. We relax around coffee and home baked goods to connect, laugh, share stories, experiences and have fun. For many, in the group this social opportunity is a chance to break through the barriers of  social isolation. For family members, it provides a chance to be understood and to speak to other family members (perhaps for the first time) without stigma or fear of judgment.

As you may have noticed, we have now officially changed our name from the Overwhelming Emotions Support Group to the Borderline Personality Support Group. This was done to clearly indicate our target audience and to address the needs of those diagnosed with BPD and their family members. We are also pleased to announce our affiliation with the Mood Disorders Association (MDA) of BC as a special interest support group. We would like to thank the MDA for their support.

It is our hope that our success will lead others to start peer-led BPD support groups in their communities. We would like to see support groups across Canada and the United States and eventually the world over. To facilitate this process, we will be posting a “how to” guide on starting a BPD support group in your area. If you have BPD or are family member of someone with the disorder, we  would love to hear about your your efforts to use the “how to” guide in starting your own support group.

Let the dream become a reality!

“Hi Elizabeth, thanks for inviting me to the support group last night. I spoke with Andrew this morning and we both agreed that it was a positive and encouraging experience. Very courageous of you to share your group with us. I always find it stressful when I’m being observed by others. I have included my notes from the meeting that I shared with the team.

Notes re observation of BPD peer support group Sept 1/10

Andrew Bucknall from intake and I attended as guests. This was tolerated well.

• Nice structure: Announcements, reading of comfort agreement, timed check-in , Open discussion, Business items.
• 7-9 Wed evening , 1st and 3rd wed on the month
• 10 people in the group: 2 peer facilitators Elisabeth and Bailey, their moms, a boyfriend, 3 individuals with BPD, 1 husband on his own, 1 wife with her husband.
• In general I would describe the group as safe, respectful and supportive
• Lots of active validation
• Leadership kept the group true to task and comfort agreement
• Lots of active use and discussion of DBT skills
• Great reinforcement of skills learned in formal DBT program
• Clients and family disclosed that prior to the group they were getting all their information from the internet
• The group had a library of books for families and clients
• The group has a blog ( bpdsupportgroup.wordpress.com) were a synopsis of the group is provided
• Group leader is actively seeking education and development opportunities with BPD fee for service program in Vancouver
• Members clearly value the group”

Thanks again Andrew and Drew.

Then tonight I had a eureka moment! It occurred to me that one of our most common themes in meetings lately is the difficulties we folks with BPD have in understanding or misinterpreting other people’s facial expressions. I think we all got a tremendous amount of insight out of the article “When Passion is the Enemy” published by Scientific American Mind and written by Molly Night Raskin. What an eye opener to realize that all our subjective observations of having difficulty reading facial expressions or reading too much into facial expressions is actually due to the disorder itself. The article reveals that “a hypersensitivity to subtle facial expressions is an important feature of borderline personality disorder.” Many people with BPD actually read a neutral facial expression as being hostile or cold. What does this mean for us folks with BPD? Well, for starters it means we know we are not alone – this is a common feature of the disorder and it is not our fault. Nevertheless, that does not mean we can’t develop coping strategies such as using mindfulness skills to avoid overreacting to situations which cause both others and ourselves emotional distress. This discovery is also important for family members and friends of those who have BPD. Armed with this knowledge, family members can work towards providing the validating environment that people with BPD thrive on, both through the use of facial expression and verbal interactions.

This has been a great summer for the group and I am proud to announce that we have developed a number of loyal attendees. Our average attendance has been 7-9 people at a meeting. Pretty good for a lazy summer!

Next meeting we will have a visitor from VIHA joining us to check us out and see what we are all about. His name is Drew and I hope you all will give him a warm welcome. Drew is a great believer in peer support/self-help and looks forward to meeting us.

Signing off for now,

Elizabeth

http://nexusnewspaper.com/articles/31545

Support Group helps those with Borderline Personalities

July 12, 2010 – Life

by Amanda Richardson – Staff Writer

Borderline Personality Disorder (BPD), a psychiatric illness dealing with overwhelming emotions and impulse control, is a condition affecting two to three percent of the world’s population. BPD affects more people than bipolar and schizophrenia combined. Yet treatment and even a diagnosis are incredibly more difficult to find.

While the term “borderline personality” might lead people to believe that BPD is in someway associate with Dissociative Identity Disorder (DID) or split personalities, it in fact has nothing to do with the person’s actual personality at all, but rather their emotional response to stimuli.

BPD occurs because of genetic and environmental factors, each playing a role in the development of the disorder. Onset is young, usually occurring between the ages of 11-14, with up to a 90 percent reduction in symptoms seen in the next 10 years. As with any personality disorder, each individual will display unique symptoms at varying degrees.

Because of the lack of resources in Victoria, BPD sufferers Elizabeth Bogod and Baylie McKnight created the peer-driven Overwhelming Emotions Support Group. While both Bogod and McKnight are health care professionals, the two take on the roles of facilitators, not experts.

“It’s really amazing,” says McKnight. “We feel like we’ve always had this group because we all understand each other. It’s a safe place where we can talk and not be judged.”

“You feel less alone there, because it’s such a lonely disorder,” agrees Bogod.

The loneliness that Bogod talks about is a symptom of BPD, which is characterized, in part, by chronic feelings of emptiness and an intense fear of abandonment.

Bogod says that she’s been dealing with BPD since she was 13, though she wasn’t formally diagnosed until she was 26. Her BPD has led to nine suicide attempts and several bouts of homelessness, although she now considers herself in recovery.

“I can self-monitor now. I can say, ‘Elizabeth, this is the BPD, this is the illness,’” says Bogod.

McKnight’s experience has been characterized more by unstable and intense relationships at a young age, as well as addiction.

“I was addicted to crystal meth for two years. Addiction is really common in BPD. It can be anything; shopping, sex, drugs. It has to do with our impulse control issues,” she says.

They say it’s important for family and friends to attend meetings so that they can learn how to best support people with BPD and connect with people who are in the same situation.

“There isn’t a whole lot that people can do for us,” explains McKnight, “except to let us shout and get it all out. The worst thing you can do to a person with BPD is tell them to calm down.”

Tips for family and friends to help diffuse overwhelming situations are discussed at meetings, like cueing and trigger words. But ultimately the group provides a safe place to discuss experiences, share knowledge and resources, and debunk myths about the illness.